They Get by With a Little Help from Their Friends: First Responders and PTSD Part 1

Social isolation is one of the classic symptoms of posttraumatic stress disorder (PTSD). It’s not necessarily that those affected have no interest in engaging in their normal activities, but the fear of persistent flashbacks and panic attacks that can arise with no apparent reason often prevents sufferers from leaving their homes — sometimes even their beds.

Understanding how the brain processes traumatic events helps explain the physiological responses and what is needed to move beyond them. One of the most important and effective strategies for someone with PTSD is social engagement with others who understand and are supportive. This is especially true for First Responders.

In working with First Responders in both the U.S. and Canada, I know that appropriate treatment that includes a strong socialization component can prevent or mitigate incidents of PTSD. Departments that utilize peer support have seen dramatic reductions in needless suffering and lost workdays among First Responders.

In this two-part series, I’ll take an in-depth look at the scientific reasoning for social engagement as an important tool to help First Responders recovering from PTSD, then will examine specific methods to use it.

The Brain in Trauma

From the time humans first existed, our bodies have been poised to protect us in any way possible. When faced with danger our brains tell us how to respond—we can choose to fight the bear (or whatever is ready to attack), or we can take flight. Additionally, there is the freeze reaction, where we become immobilized. This act of playing possum, or pretending to be asleep, unconscious or dead, might just trick the bear into ignoring us and moving along.

The freeze response is a failsafe survival mechanism. It kicks in when neither fighting nor fleeing is possible. The freeze response is a product of the vagus nerve, one of the largest nerves in the body. The vagus nerve typically helps us maintain a smooth psychological balance between arousal and relaxation. It helps control the lungs, heart, and stomach. But when we are faced with a threat, the vagus nerve becomes dysfunctional and essentially shuts down these systems. The result can range from a slight inability to think clearly to fainting.

As humans have evolved, a new branch of the vagus nerve has emerged. It is partially responsible for our expressions and is active in social engagement. When this part of the vagus nerve is active, we seek social engagement as a means to calm us and lessen the need for oxygen and food.

Some people who are faced with trauma have a freeze response. This indicates that their vagus nerve is not working as it should. When the vagus nerve is out of whack, the gut, heart and brain don’t function properly. Technically, these are our three brains (gut, heart and brain), and since the gut and heart are predominantly made up of neurotransmitter cells, the vagus nerve is the communication pathway for synchronization between all three organs. Adding to this is the fact that experiencing a traumatic event can result in memories getting filed in the wrong places in the brain. Therefore, a thought or stimuli that occurred just before the trauma can become jumbled together with the horrific event itself and trigger a flashback in which the person feels as if he is reliving it.

For example, a police officer looking at paperwork shortly before he is called to a mass shooting may subsequently re-experience the trauma whenever he sees something that was on the paperwork. Even though the two events are unrelated, his brain has intertwined the memories. It explains why people with PTSD have panic attacks for no apparent reason.

Regulating the vagus nerve settles down these various responses. It calms the stomach, heart and brain, and helps file memories correctly. Engaging in social interaction is one of the key steps to help the vagus nerve get back on track and regulate a psychological balance again.

PTSD installs feelings of loss of control and safety. Others with a clear understanding of that can help First Responders recoup trust. Debriefing — a process of helping the PTSD sufferer sort out which facts are related and which are unrelated to the trauma — is most successful when done in groups of peers.

A study of police officers in Canada revealed that a lack of social support from colleagues during, and immediately after a traumatic event was a strong risk factor for developing PTSD. Also, a perception of negative social interactions after a trauma was cited as another risk factor. A workplace with a stressful, unsupportive atmosphere is more likely to have PTSD cases than one with a supportive environment.

Conclusion

Social engagement among peers is one of, if not the most important steps to help First Responders recover from PTSD.

In Part II of this series, I’ll explain what peer counseling is, provide proven results and discuss best practices.

IMCS is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.